Provider Demographics
NPI:1205809704
Name:SPEARS, WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:SPEARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 E WASHINGTON BLVD
Mailing Address - Street 2:107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1409
Mailing Address - Country:US
Mailing Address - Phone:626-791-1168
Mailing Address - Fax:626-791-4737
Practice Address - Street 1:2595 E WASHINGTON BLVD
Practice Address - Street 2:107
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-1409
Practice Address - Country:US
Practice Address - Phone:626-791-1168
Practice Address - Fax:626-791-4737
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G344410Medicaid
CAG34441Medicare ID - Type UnspecifiedPROVIDER NUMBER
CA00G344410Medicaid